Grid and rotatable cube guide localization fixture for biopsy device

ABSTRACT

A biopsy system with a grid plate used as either a lateral or medial compression plate of a localization fixture used with a breast coil includes a rotatable guide cube that may be inserted into a desired rectangular recess in the grid plate after rotating to position a selected guide hole in the desired spatial orientation. Versions of a guide cube include those rotatable in two axes to provide additional hole positions, angled holes, enlarged circular holes that function with a rotating guide to support a noncircular biopsy instrument cannula (e.g., trocar/sleeve combination, core biopsy probe of a biopsy device) for rotation. A rotating guide may have an unlocked state for easily sliding to a selected longitudinal position thereon. Thereafter, the rotating guide is locked to serve as a positive depth stop (e.g., quarter turn locking elastomeric rings, triangular and scissor clips, and shutter depth stops).

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is related to the co-pending and commonly-ownedU.S. patent application Ser. No. 11/414,988, “BIOPSY CANNULA ADJUSTABLEDEPTH STOP” to Hibner et al., filed on even date herewith, thedisclosure of which is hereby incorporated by reference in its entirety.

FIELD OF THE INVENTION

The present invention relates in general to biopsy devices, and moreparticularly to biopsy devices having a cutter for severing tissue, andeven more particularly to a localization and guidance fixture thatguides insertion of a probe, or a sleeve that subsequently receives theprobe of a biopsy device.

BACKGROUND OF THE INVENTION

When a suspicious tissue mass is discovered in a patient's breastthrough examination, ultrasound, MRI, X-ray imaging or the like, it isoften necessary to perform a biopsy procedure to remove one or moresamples of that tissue in order to determine whether the mass containscancerous cells. A biopsy may be performed using an open or percutaneousmethod.

An open biopsy is performed by making a large incision in the breast andremoving either the entire mass, called an excisional biopsy, or asubstantial portion of it, known as an incisional biopsy. An open biopsyis a surgical procedure that is usually done as an outpatient procedurein a hospital or a surgical center, involving both high cost and a highlevel of trauma to the patient. Open biopsy carries a relatively higherrisk of infection and bleeding than does percutaneous biopsy, and thedisfigurement that sometimes results from an open biopsy may make itdifficult to read future mammograms. Further, the aestheticconsiderations of the patient make open biopsy even less appealing dueto the risk of disfigurement. Given that a high percentage of biopsiesshow that the suspicious tissue mass is not cancerous, the downsides ofthe open biopsy procedure render this method inappropriate in manycases.

Percutaneous biopsy, to the contrary, is much less invasive than openbiopsy. Percutaneous biopsy may be performed using fine needleaspiration (FNA) or core needle biopsy. In FNA, a very thin needle isused to withdraw fluid and cells from the suspicious tissue mass. Thismethod has an advantage in that it is very low-pain, so low-pain thatlocal anesthetic is not always used because the application of it may bemore painful than the FNA itself. However, a shortcoming of FNA is thatonly a small number of cells are obtained through the procedure,rendering it relatively less useful in analyzing the suspicious tissueand making an assessment of the progression of the cancer less simple ifthe sample is found to be malignant.

During a core needle biopsy, a small tissue sample is removed allowingfor a pathological assessment of the tissue, including an assessment ofthe progression of any cancerous cells that are found. The followingpatent documents disclose various core biopsy devices and areincorporated herein by reference in their entirety: U.S. Pat. No.6,273,862 issued Aug. 14, 2001; U.S. Pat. No. 6,231,522 issued May 15,2001; U.S. Pat. No. 6,228,055 issued May 8, 2001; U.S. Pat. No.6,120,462 issued Sep. 19, 2000; U.S. Pat. No. 6,086,544 issued Jul. 11,2000; U.S. Pat. No. 6,077,230 issued Jun. 20, 2000; U.S. Pat. No.6,017,316 issued Jan. 25, 2000; U.S. Pat. No. 6,007,497 issued Dec. 28,1999; U.S. Pat. No. 5,980,469 issued Nov. 9, 1999; U.S. Pat. No.5,964,716 issued Oct. 12, 1999; U.S. Pat. No. 5,928,164 issued Jul. 27,1999; U.S. Pat. No. 5,775,333 issued Jul. 7, 1998; U.S. Pat. No.5,769,086 issued Jun. 23, 1998; U.S. Pat. No. 5,649,547 issued Jul. 22,1997; U.S. Pat. No. 5,526,822 issued Jun. 18, 1996; and U.S. PatentApplication 2003/0199753 published Oct. 23, 2003 to Hibner et al.

In U.S. Pat. Appln. Publ. No. 2005/0283069A1, “MRI biopsy devicelocalization fixture” to Hughes et al., the disclosure of which ishereby incorporated by reference in its entirety, a localizationmechanism, or fixture, is described that is used in conjunction with abreast coil for breast compression and for guiding a core biopsyinstrument during prone biopsy procedures in both open and closedMagnetic Resonance Imaging (MRI) machines. The localization fixtureincludes a three-dimensional Cartesian positionable guide for supportingand orienting an MRI-compatible biopsy instrument, and, in particular, asleeve to a biopsy site of suspicious tissues or lesions. A z-stopenhances accurate insertion, and prevents over-insertion or inadvertentretraction of the sleeve.

While this three-axes localization fixture has a large number ofadvantages, including supporting a handle of the biopsy device duringhands off portions of the procedure, some clinicians prefer, or are atleast more familiar with, other approaches to guiding a probe of abiopsy device. For instance, an EnCor™ Needle Guide Block by SenoRx® ofAliso Viejo, Calif., which has a plurality of needle holes between afront and a back face, is inserted into a grid localization fence forguiding an EnCor™ cannula that in turn guides a trocar, obturator orprobe of a biopsy device. The guide block may rotate about thelongitudinal axis of the block to present more options for an insertionpoint into breast tissue. A polymeric ring is inserted over the cannulato give a visual indication to the clinician as to the depth ofinsertion of the cannula/trocar. A perceived benefit of this approach isan intuitive guidance mechanism with relatively inexpensive disposablecomponents.

While these guidance options have clinical effectiveness, a significantdesire remains for additional refinements that accurately guide a probefor taking a core biopsy sample.

SUMMARY OF THE INVENTION

The present invention addresses these and other problems of the priorart by providing an apparatus for locating a breast of a patient andguiding a biopsy instrument cannula for insertion into tissue, whereinone of two compression surfaces that are positioned relative to apatient support surface to opposingly compress the patient's breast, isa grid plate having a plurality of grid apertures. The orientation ofguide holes formed in the guide cube enhance options for positioning theguide cube to closely position an insertion point.

In one aspect of the invention, a guide device, with guide holes passingtransversely to one another between differing pairs of opposing faces,is inserted into a selected one of the guide apertures. A groundingstructure between the guide device and the grid plate prevents the guidecube from passing out of a distal side of the grid plate presentedagainst the patient. Thereby, an intuitive approach to guiding a biopsyinstrument by placing a guide cube is enhanced by providing multiplefaces of the device that may contain centered or off center guide holes.Placing a pair of closely positioned guide holes on the same face mayotherwise not effectively guide the biopsy instrument with too much holeoverlap. Portions of the biopsy instrument that are not in contact withthe guide hole increase force in other areas that may lead to bending orfracture.

In another aspect of the invention, a guide device sized for insertioninto the grid plate has guide holes that pass nonorthogonally betweenproximal and distal faces of the guide device. Thereby, an angle ofinsertion may be selected that is not merely orthogonal to the gridplate.

In yet another aspect of the invention, an intermediary device of arotating guide is received over a biopsy instrument, which in turn isreceived into an enlarged guide hole in a guide cube inserted into thegrid plate. The rotating guide thus may serve purposes such aspresenting a circular transverse cross section to allow rotation of anonround biopsy instrument cannula. To give a number of hole positionswithin a selected grid aperture, a set of guide cubes are presented as aset, each with various unique positions of one or more guide holes.Selecting a guide cube thus gives enhanced flexibility in positioningthe insertion point.

These and other objects and advantages of the present invention shall bemade apparent from the accompanying drawings and the descriptionthereof.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims particularly pointing outand distinctly claiming the present invention, it is believed the samewill be better understood by reference to the following description,taken in conjunction with the accompanying drawings in which:

FIG. 1 is an isometric view of a biopsy system including a controlmodule remotely coupled to a biopsy device, and including a localizationfixture with a lateral grid plate used in conjunction with a rotatablecube to position a trocar/obturator or a probe of the biopsy device to adesired insertion depth as set by a ring stop.

FIG. 2 is an isometric view of the breast coil receiving thelocalization fixture of FIG. 1.

FIG. 3 is an isometric view of the biopsy device inserted through therotatable cube within the cube plate of the localization fixtureattached to a breast coil of FIG. 1.

FIG. 4 is an isometric view of a two-axis rotatable guide cube of thebiopsy system of FIG. 1.

FIG. 5 is a diagram of nine guide positions achievable by the two-axisrotatable guide cube of FIG. 5.

FIG. 6 is an isometric view of a two-axis rotatable guide cube insertedinto a lateral grid with the backing of the localization fixture of FIG.1.

FIG. 7 is an isometric view of the trocar and sleeve of the biopsysystem of FIG. 1.

FIG. 8 is an isometric exploded view of the trocar and sleeve of FIG. 7.

FIG. 9 is an isometric view of a trocar and sleeve of FIG. 7 with adepth stop deice of FIG. 1 inserted through the guide cube and gridplate of FIG. 6.

FIG. 10 is an alternative guide cube for the biopsy system of FIG. 1with two-axes of rotation and self-grounding features.

FIG. 11 is an isometric view of the trocar and sleeve of FIG. 7 insertedinto one of two guide cubes of FIG. 10 inserted into the grid plate ofFIG. 1.

FIG. 12 is an aft isometric view of a further alternative guide cubewith four angled, parallel guide holes for the biopsy system of FIG. 1.

FIG. 13 is a front isometric view of the guide cube of FIG. 12.

FIG. 14 is a right side view of the guide cube of FIG. 12 with theangled, parallel guide holes depicted in phantom.

FIG. 15 is an aft view in elevation of yet another alternative guidecube for the biopsy system of FIG. 1 with a pair of converging guideholes and a pair of diverging guide holes.

FIG. 16 is a left side view of the guide cube of FIG. 15 taken in crosssection along lines 16-16 through the pair of converging guide holes.

FIG. 17 is a left side view of the guide cube of FIG. 15 taken in crosssection along lines 17-17 through the pair of diverging guide holes.

FIG. 18 is an isometric view of a two hole guide cube for the biopsysystem of FIG. 1.

FIG. 19 is an isometric view of a one-hole guide cube for the biopsysystem of FIG. 1.

FIG. 20 is a rotating guide for guiding the trocar and sleeve of FIG. 7into either of the two-hole guide cube of FIG. 18 or the one-hole guidecube of FIG. 19.

FIG. 21 is an aft isometric view of the trocar and sleeve of FIG. 7inserted through the rotating guide of FIG. 20 into the two-hole guidecube of FIG. 18.

FIG. 22 is an isometric locking O-ring for the biopsy system of FIG. 1.

FIG. 23 is an aft view of the locking O-ring of FIG. 22 with a crosssection of a biopsy instrument cannula shown in both an unlockedorientation and rotated a quarter turn into a locked orientationdepicted in phanton.

FIG. 24 is an isometric view of a cylindrical rotating guide formed ofelastomeric material with an oval through hole for the biopsy system ofFIG. 1.

FIG. 25 is an aft view of the cylindrical rotating guide of FIG. 24 witha cross sectional view of an unlocked oval-shaped biopsy instrumentcannula inserted in the oval through hole.

FIG. 26 is an aft view of the cylindrical rotating guide and biopsyinstrument cannula of FIG. 25 with the cylindrical rotating guiderotated a quarter turn relative to the cannula to elastomerically lockthereon.

FIG. 27 is an isometric view of a flattened oval rotating guide for thebiopsy system of FIG. 1.

FIG. 28 is an isometric view of a triangular clip depth stop for thebiopsy system of FIG. 1.

FIG. 29 is an isometric view of a scissor-like depth stop clip for thebiopsy system of FIG. 1.

FIG. 30 is an aft isometric view of a shutter depth stop with insertedbiopsy instrument cannula for the biopsy system of FIG. 1.

FIG. 31 is an aft view of the shutter depth stop of FIG. 30 prior touse.

FIG. 32 is a front isometric view of the shutter depth stop and insertedbiopsy instrument cannula of FIG. 30.

FIG. 33 is an aft view of the shutter depth stop and biopsy instrumentcannula of FIG. 30 with the shutter depth stop vertically compressedinto an unlocked state.

DETAILED DESCRIPTION OF THE INVENTION

Turning to the Drawings, wherein like numerals denote like componentsthroughout the several views, in FIGS. 1-3, a Magnetic Resonance Imaging(MRI) compatible biopsy system 10 has a control module 12 that typicallyis placed outside of a shielded room containing an MRI machine (notshown) or at least spaced away to mitigate detrimental interaction withits strong magnetic field and/or sensitive radio frequency (RF) signaldetection antennas. As described in U.S. Pat. No. 6,752,768, which ishereby incorporated by reference in its entirety, a range ofpreprogrammed functionality is incorporated into the control module 12to assist in taking these tissue samples. The control module 12 controlsand powers an MRI biopsy device 14 that is positioned and guided by alocalization fixture 16 attached to a breast coil 18 that is placed upona gantry (not shown) of the MRI machine.

The control module 12 is mechanically, electrically, and pneumaticallycoupled to the MRI biopsy device 14 so that components may be segregatedthat need to be spaced away from the strong magnetic field and thesensitive RF receiving components of the MRI machine. A cable managementspool 20 is placed upon a cable management attachment saddle 22 thatprojects from a side of the control module 12. Wound upon the cablemanagement spool 20 is a paired electrical cable 24 and mechanical cable26 for communicating control signals and cutter rotation/advancementmotions respectively. In particular, electrical and mechanical cables24, 26 each have one end connected to respective electrical andmechanical ports 28, 30 in the control module 12 and another endconnected to a reusable holster portion 32 of the MRI biopsy device 14.An MRI docking cup 34, which may hold the holster portion 32 when not inuse, is hooked to the control module 12 by a docking station mountingbracket 36.

An interface lock box 38 mounted to a wall provides a tether 40 to alockout port 42 on the control module 12. The tether 40 isadvantageously uniquely terminated and of short length to precludeinadvertent positioning of the control module 12 too close to the MRImachine. An in-line enclosure 44 may advantageously register the tether40, electrical cable 24 and mechanical cable 26 to their respectiveports 42, 28, 30 on the control module 12.

Vacuum assist is provided by a first vacuum line 46 that connectsbetween the control module 12 and an outlet port 48 of a vacuum canister50 that catches liquid and solid debris. A tubing kit 52 completes thepneumatic communication between the control module 12 and the MRI biopsydevice 14. In particular, a second vacuum line 54 is connected to aninlet port 56 of the vacuum canister 50. The second vacuum line 54divides into two vacuum lines 58, 60 that are attached to the MRI biopsydevice 14. With the MRI biopsy device 14 installed in the holsterportion 32, the control module 12 performs a functional check. Saline ismanually injected into biopsy device 14 to serve as a lubricant and toassist in achieving a vacuum seal. The control module 12 actuates acutter mechanism (not shown) in the MRI biopsy device 14, monitoringfull travel. Binding in the mechanical cable 26 or within the biopsydevice 14 is monitored with reference to motor force exerted to turn themechanical cable 26 and/or an amount of twist in the mechanical cable 26sensed in comparing rotary speed or position at each end of themechanical cable 26.

A remote keypad 62, which is detachable from the reusable holsterportion 32, communicates via the electrical cable 24 to the controlpanel 12 to enhance clinician control of the MRI biopsy device 14,especially when controls that would otherwise be on the MRI biopsydevice 14 itself are not readily accessible after insertion into thelocalization fixture 16 and/or placement of the control module 12 isinconveniently remote (e.g., 30 feet away). An aft end thumbwheel 63 onthe reusable holster portion 32 is also readily accessible afterinsertion to rotate the side from which a tissue sample is to be taken.

Left and right parallel upper guides 64, 66 of a localization framework68 are laterally adjustably received respectively within left and rightparallel upper tracks 70, 72 attached to an under side 74 and to eachside of a selected breast aperture 76 formed in a patient supportplatform 78 of the breast coil 18. A base 80 of the breast coil 18 isconnected by centerline pillars 82 that are attached to the patientsupport platform 78 between the breast apertures 76. Also, a pair ofouter vertical support pillars 84, 86 on each side spaced about arespective breast aperture 76 respectively define a lateral recess 88within which the localization fixture 16 resides.

It should be appreciated that the patient's breasts hang pendulouslyrespectively into the breast apertures 76 within the lateral recesses88. For convenience, herein a convention is used for locating asuspicious lesion by Cartesian coordinates within breast tissuereferenced to the localization fixture 16 and to thereafter selectivelyposition an instrument, such as a probe 90 (FIG. 1) of a disposableprobe assembly 91 that is engaged to the reusable holster portion 32 toform the MRI biopsy device 14. To enhance hands off use of the biopsysystem 10, especially for repeated reimaging within the narrow confinesof a closed bore MRI machine, the MRI compatible biopsy system 10 mayalso guide a trocar (“introducer”) 92 encompassed by a sleeve 94. Depthof insertion is controlled by a depth stop device 95 longitudinallypositioned on either the probe 90 or the sleeve 94.

This guidance is specifically provided by a lateral fence, depicted as agrid plate 96, which is received within a laterally adjustable outerthree sided plate bracket 98 attached below the left and right parallelupper guides 64, 66. Similarly, a medial fence with respect to a medialplane of the chest of the patient, depicted as a medial plate 100, isreceived within an inner three-sided plate bracket 102 attached belowthe left and right parallel upper guides 64, 66 close to the centerlinepillars 82 when installed in the breast coil 18. To further refine theinsertion point of the instrument (e.g., probe 90, trocar/sleeve 92,94), a guide cube 104 is inserted into the backside of the grid plate96.

The selected breast is compressed along an inner (medial) side by themedial plate 100 and on an outside (lateral) side of the breast by thegrid plate 96, the latter defining an X-Y plane. The X-axis is vertical(sagittal) with respect to a standing patient and corresponds to aleft-to-right axis as viewed by a clinician facing the externallyexposed portion of the localization fixture 16. Perpendicular to thisX-Y plane extending toward the medial side of the breast is the Z-axis,which typically corresponds to the orientation and depth of insertion ofthe probe 90 of the MRI biopsy device 14 or the trocar/sleeve 92, 94.For clarity, the term Z-axis may be used interchangeably with “axis ofpenetration”, although the latter may or may not be orthogonal to thespatial coordinates used to locate an insertion point on the patient.Versions of the localization fixture 16 described herein allow anonorthogonal axis of penetration to the X-Y axis to a lesion at aconvenient or clinically beneficial angle.

In FIG. 4, guide cube 104 includes a central guide hole 106, a cornerguide hole 108, and an off-center guide hole 110 that pass orthogonallyto one another between respective opposite pairs of faces 112, 114, 116.By selectively rotating the guide cube 104 in two axis, one of the pairsof faces 112, 114, 116 may be proximally aligned to an unturned positionand then the selected proximal face 112, 114, 116 optionally rotated aquarter turn, half turn, or three quarter turn. Thereby, one of nineguide positions 118 (i.e., using central guide hole 106), 120 a-120 d(i.e., corner guide hole 108), 122 a-122 d (i.e., using off-center guidehole 110) may be proximally exposed as depicted in FIG. 5.

In FIG. 6, the two-axis rotatable guide cube 104 is sized for insertionfrom a proximal side into one of a plurality of square recesses 130 inthe grid plate 96 formed by intersecting vertical bars 132 andhorizontal bars 134. The guide cube 104 is prevented from passingthrough the grid plate 96 by a backing substrate 136 attached to a frontface of the grid plate 96. The backing substrate 136 includes arespective square opening 138 centered within each square recess 130,forming a lip 140 sufficient to capture the front face of the guide cube104 but not so large as to obstruct the guide holes 104, 106, 108. Thedepth of the square recesses 130 is less than the guide cube 104,thereby exposing a proximal portion 142 of the guide cube 104 forseizing and extraction from the grid plate 96.

In FIGS. 7-9, in the illustrative version, the trocar 92 is slid intothe sleeve 94 and the combination is guided through the guide cube 104(FIG. 9) to the biopsy site within the breast tissue. The sleeve 94includes a hollow shaft (or cannula) 196 that is proximally attached toa cylindrical hub 198 and has a lateral aperture 200 proximate to anopen distal end 202. The cylindrical hub 198 has an exteriorly presentedthumbwheel 204 for rotating the lateral aperture 200. The cylindricalhub 198 has an interior recess 206 that encompasses a duckbill seal 208,wiper seal 210 and a seal retainer 212 to provide a fluid seal when theshaft 196 is empty and for sealing to the inserted introducer (trocar)92. Longitudinally spaces measurement indicia 213 along an outer surfaceof the hollow shaft 196 visually, and perhaps physically, provide ameans to locate the depth stop device 95 of FIG. 1.

The trocar 92 advantageously incorporates a number of components withcorresponding features. A hollow shaft 214 includes a fluid lumen 216that communicates between an imagable side notch 218 and a proximal port220. The hollow shaft 214 is longitudinally sized to extend, when fullyengaged, a piercing tip 222 out of the distal end 202 of the sleeve 94.An obturator thumbwheel cap 224 encompasses the proximal port 220 andincludes a locking feature 226, which includes a visible angle indicator228 (FIG. 8), that engages the sleeve thumbwheel 204 to ensure that theimagable side notch 218 is registered to the lateral aperture 200 in thesleeve 94. An obturator seal cap 230 may be engaged proximally into theobturator thumbwheel cap 224 to close the fluid lumen 216. The obturatorseal cap 230 includes a locking or locating feature 232 that includes avisible angle indicator 233 that corresponds with the visible angleindicator 228 on the obturator thumbwheel cap 224, which may befashioned from either a rigid, soft, or elastomeric material. In FIG. 9,the guide cube 104 has guided the trocar 92 and sleeve 94 through thegrid plate 96.

In FIGS. 10-11, an alternative guide cube 104 a has rotation in two axesbut is self-grounding by means of an added rectangular prism 240 whichhas a shared edge with a cubic portion 242 of the guide cube 104 a. Whenviewed orthogonally to the shared cube edge, a larger square face 244 ofthe cubic portion 242 overlaps with a smaller square face 246 of therectangular prism 240 to correspond with the desired size of an exposedproximal portion 248 of the inserted guide cube 104 a. The rectangularprism 240 allows proximal exposure of one of two adjacent faces 250, 252of the guide cube 104 a and then turning each to one of four quarterturn rotational positions. In the illustrative version, first face. 250has a central guide hole 106 a and the second face 252 has a cornerguide hole 108 a, and an off-center guide hole 110 a. A radial recess254 is relieved into the rectangular prism 240 to allow grounding of thedepth stop device 95 against the face 252 when the off-center guide hole110 a is used.

In FIGS. 12-14, another alternative guide cube 104 b has a proximalenlarged hat portion 270 about a proximal face 271 that grounds againstthe selected square recess 130 in the grid plate 96 (FIG. 6) and allowsrotation about one axis to one of four quarter turn positions. Fourangled guide holes 272 a, 272 b, 272 c, 272 d allow accessing not onlyan increased number of insertion points within the selected squarerecess 130 but also a desired angle of penetration rather than beingconstrained to a perpendicular insertion.

In FIGS. 15-17, an additional alternative guide cube 104 c also has theproximal enlarged hat portion 270 about the proximal face 271 thatgrounds against the selected square recess 130 in the grid plate 96(FIG. 6) and allows rotation about one axis to one of four quarter turnpositions. The guide holes are depicted as a first pair of convergingangled through holes 310 a, 310 b having outwardly spaced proximalopenings 311 a, 311 b (FIG. 15), respectively, that communicate withpartially intersecting distal openings 312 a, 312 b, respectively. Theguide holes are also depicted as a second pair of diverging angledthrough holes 310 c, 310 d having partially intersecting proximalopenings 311 c, 311 d, respectively, that communicate with outwardlyspaced distal openings 312 c, 312 d.

In FIG. 18, a further alternative two-hole guide cube 104 d has twoenlarged guide holes 330, 332 accessed through the proximal face 271 inthe enlarged proximal hat portion 270. Similarly, in FIG. 19, a one holeguide cube 104 e has one enlarged guide hole 334 accessed through theproximal face 271 in the enlarged proximal hat portion 270. Each guidecube 104 d, 104 e may receive a cylindrical rotating guide 336 (FIG. 20)with an integral, proximal depth ring stop 338. In FIGS. 20, 21, athrough hole 340 in the cylindrical guide 336 is sized to receive abiopsy instrument cannula (e.g., probe 90, sleeve 94) by being oval incross section in the illustrative version. It should be appreciated thatthe cylindrical guide 336 may provide structural support to the guidedportion of the biopsy instrument support as well as facilitate axialrotation thereof, especially for a non cylindrical biopsy instrumentcannula.

It should be appreciated that the two-hole and one-hole guide cubes 104d, 104 e and rotating guide 336 may comprise a guide cube set, perhapswith additional guide cubes (not shown) having uniquely positioned guideholes. With the enlarged guide holes 330-340 to accommodate the rotatingguide 336, too much overlap of guide holes (e.g., 330, 332) may resultin insufficient support by the rotating guide 336 for the insertedbiopsy instrument cannula. Thus, fine positioning is accomplished byselecting one of the available guide cubes 104 d, 104 e for the desiredposition within a selected grid aperture.

In FIGS. 22, 23, a locking O-ring feature may be advantageouslyincorporated into a depth ring stop (rotating guide) 350. Having to relyupon constant frictional engagement of the depth ring stop (rotatingguide) 350 alone would result in difficulty in installing the ring stop350 to the desired position or being too readily displaced to serve as astopping structure. In the exemplary version, an outer circumferencesurface 351 of the ring stop 350 includes left and right outerlongitudinal ridges 352, 354 that aid in gripping and orienting thedepth ring stop 350 while turning for locking and unlocking. As viewedfrom behind, opposing inner longitudinal ridges 356, 358 formed in agenerally cylindrical inner diameter 359 abut respectively at an upperleft and lower right side of an oval cannula 360 (FIG. 23) oriented withits elongate cross section vertically in an unlocked position. The innerlongitudinal ridges 356, 358 allow a quarter turn clockwise of the ovalcannula, depicted as 360′, to a locked position deforming an innertangential locking rib 362.

It should be appreciated that these orientations and geometry areillustrative. An amount of rotation to lock and unlock, for instance,may be less than or more than a quarter turn. In addition, noncircularfeatures on an outer diameter of the depth ring stop 350 may be omitted.Other variations may be employed. For example, in FIGS. 24-25, acylindrical rotating guide 380, formed of a resilient polymer has anelongate through hole 382 shaped to permit insertion of an oval biopsycannula 384. In FIG. 26, turning the cylindrical rotating guide 380 aquarter turn in either direction to a locked position, depicted at 380′,causes the cylindrical rotating guide 380′ to deform, binding onto thebiopsy instrument cannula 384, thereby serving as a depth stop.

Similarly, in FIG. 27, a rotating guide 400 is oval shaped withflattened elongate sides and with a corresponding elongate through hole402. The outer shape may be tactile, advantageous for gripping as wellas provide a visual indication of being locked or unlocked. A resilienttangential rib 404 crossing one inner corner of the elongate throughhole 402 is positioned to bind against an inserted biopsy instrumentcannula (not shown) when the rotating guide 400 is turned a quarter turnto a locking position.

In FIG. 28, a triangular clip depth stop 420 has a transverse frontsurface 422 with a proximally turned lower lip 424 and an upper lateraledge 426 attached to a downwardly and proximally ramped member 428 whoselower lateral edge 430 bends distally to form a horizontal lockingactuator member 432 whose distal edge 434 rests upon the lower lip 424.A front vertically elongate aperture 436 in the transverse front surface422 is shaped to approximate the outer diameter of an inserted biopsyinstrument cannula (not shown). An aft elongate aperture 438 formed inthe downwardly and proximally ramped member 428 is a distal horizontalprojection of the front vertically elongate aperture 436 when thelocking actuator member 432 is upwardly raised, thus allowing insertionof the biopsy instrument cannula through both apertures 436, 438. Uponrelease of the locking actuator member 432, an upper inner surface 440of the aft elongate aperture 438 lowers, binding upon the insertedbiopsy instrument cannula, allowing the transverse front surface 422 toserve as a positive depth stop.

In FIG. 29, a scissor-like clip depth stop 450 is cut out of a layer ofresilient material. In particular, an upper arm portion 452 and a lowerarm portion 454 are attached to one radiating vertically away from eachother toward the same lateral side (right as depicted) from a splitcylindrical grasping portion 456 separated longitudinally on a lateralside opposite to the arm portions 452, 454 (left as depicted). Inparticular, an upper gripping half-cylindrical member 458 is attached atits right side to a lower portion 460 of the upper arm portion 452. Alower gripping half-cylindrical member 462 is attached at its right sideto an upper portion 464 of the lower arm portion 454. An upperhemispheric portion 466 of the upper arm portion 452 includes an upperfinger hole 468. A lower hemispheric portion 470 of the lower armportion 454 includes a lower finger hole 472. A triangular recess 474(opening rightward as depicted) formed by the arm portions 452, 454 anda longitudinal pin 476 inserted at the juncture between the arm portions452, 454 predispose the arm portions 452, 454 to be resiliently drawntoward each other as the finger holes 468, 472 are gripped and movedtogether, thereby opening the upper and lower gripping half cylindricalmembers 458, 462, widening the separation of their left ends. In thisunlocked position, a biopsy instrument cannula (not shown) may beinserted and positioned to a desired depth.

In FIG. 30-33 a shuttered depth stop 600 includes a resilient oval shell602 with a corresponding oval aperture 604 with an upper right tab 606projecting inwardly to the left and with a lower left tab 608 projectinginwardly to the right when viewed from behind (FIG. 30). An upperresilient member 610 has a generally horseshoe-shaped outer surface 612that conforms to an upper portion 614 of the oval aperture 604. A lowerresilient member 616 has a generally horseshoe-shaped outer surface 618that conforms to a lower portion 620 of the oval aperture 604. In theillustrative version, the upper and lower resilient members 610, 616 areidentical but are rotated a half turn about a longitudinal axis withrespect to each other. Moreover, the entire shuttered depth stop 600 issymmetric about its vertical axis defined by its longest dimension orabout a horizontal axis defined by its second longest dimension.

A downwardly open rectangular prismatic recess. 622 formed in the upperresilient member 610 is sized to receive an upper shutter 624 having anupper center tab 626 and a lower acute edge 628. A top centerrectangular slot 630 formed in the upper resilient member 610communicates with the downwardly open rectangular prismatic recess 622and receives the upper center tab 626. An upwardly open rectangularprismatic recess 632 formed in the lower resilient member 616 is sizedto receive a lower shutter 634 having a lower center tab 636 and anupper acute edge 638. A bottom center rectangular slot 639 formed in thelower resilient member 616 communicates with the upwardly openrectangular prismatic recess 632 and receives the lower center tab 636.An upper horizontal pin 640 attached horizontally as depicted across theupper shutter 624 is received for rotation onto opposite lateral sidesof the downwardly open rectangular prismatic recess 622. A lowerhorizontal pin 642 attached horizontally as depicted across the lowershutter 634 is received for rotation onto opposite lateral sides of theupwardly open rectangular prismatic recess 632.

The right side of the upper resilient member 610 includes a rightoutward shoulder 644 that rests upon the upper right tab 606 of theresilient oval shell 602. A laterally recessed downward arm 646 isattached to the right shoulder 644 and extends downwardly with its outersurface 648 vertically aligned with an innermost edge 650 of the rightoutward shoulder 644 and with its inner surface 652 defining thedownwardly open generally rectangular prismatic recess 622. The leftside of the upper resilient member 610 includes a left inward shoulder654 that is laterally aligned with and opposite of the upper right tab606 of the resilient oval shell 602. An outer downward arm 656 isattached to the left inward shoulder 654 and extends downwardly with itsouter surface 658 against oval aperture 604 and an innermost edge 660vertically aligned with an inner surface 662 of the lower left tab 608upon which the outer downward arm 656 rests.

Similarly, the lower resilient member 616 includes a left outwardshoulder 664 attached to a laterally recessed upward arm 666 and a rightinward shoulder 668 attached to an outer upward arm 670 that abuts anunderside of the upper right tab 606. The laterally recessed downwardarm 646 of the upper resilient member 610 extends downward past thelongitudinal centerline of the shuttered depth stop 600 and an insertedbiopsy instrument cannula 672. A lower edge 674 of the laterallyrecessed downward arm 646 is spaced away from an upper surface 676 ofthe right inward shoulder 668. In addition, an upper edge 678 of thelaterally recessed upward arm 666 is spaced away from a lower surface680 of the left inward shoulder 654. When the resilient oval shell 602is relaxed as in FIGS. 30-32, this spacing between the left inwardshoulder 654 and the upper edge 678 of the laterally recessed upward arm666 defines an upper left rectangular recess 682 communicating rightwardinto the downwardly open rectangular prismatic recess 622 and sized toallow unimpeded swinging of a leftward extension 684 of the uppershutter 624. Spacing between the upper surface 676 of the right inwardshoulder 668 and the lower edge 674 of the laterally recessed downwardarm 646 defines a lower right rectangular recess 686 which communicatesleftward into the upwardly open rectangular prismatic recess 632 whichis sized to allow unimpeded swinging of a rightward extension 688 of thelower shutter 634.

In FIG. 31, the shuttered depth stop 600 initially has closed upper andlower shutters 624, 634 due to restoring pressure from the top centerrectangular slot 630 on the upper center tab 626 and from the bottomcenter rectangular slot 639 on the lower center tab 636 respectively.Insertion of a biopsy instrument cannula 672 from a selected side (thusthe aft side) causes the upper and lower acute edges 628, 638 of theshutters 624, 634 to swing distally and outwardly but remain in contactdue to the restoring pressure previously mentioned. Proximal retractionof the biopsy instrument cannula 672 frictionally rotates the acuteedges 628, 638 proximally, and thus inwardly, binding upon the biopsyinstrument cannula 672 preventing inadvertent retraction to serve as adepth stop. When retraction is desired, squeezing the resilient ovalshell 602 to reduce the vertical height of the shutter depth stop 600 inFIG. 33 causes the laterally recessed downward arm 646 to open the lowershutter 634 and the laterally recessed upward arm 666 to open the uppershutter 624.

Alternatively, it should be appreciated that a single shutter may beemployed in a shuttered depth stop consistent with aspects of theinvention. As a further alternative or as an additional feature, groovesin the biopsy cannula may enhance engagement of one or two shutters tofurther avoid inadvertent proximal retraction of the positionedshuttered depth stop. Moreover, the grooves on the biopsy cannula may beramped such that engagement is more prevalent against proximalretraction as compared to distal positioning. Further, such grooves maybe along only a portion of the circumference of the biopsy cannula suchthat rotation of the shuttered depth stop also further unlocks from thebiopsy cannula for positioning.

It should be appreciated that straight upper and lower acute edges 628,638 of the two shutters 624, 634 may instead be contoured to closelyapproximate the transverse cross section of the encompassed shuttereddepth stop 600 to increase the locking against inadvertent retraction.

While the present invention has been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art.

For example, other imaging modalities may benefit from aspects of thepresent invention.

It should be appreciated that a grid plate 96 with a backing lip 140 maybe used such that a guide cube rotatable to each of the six faces withfour quarter turn positions for each face may achieve a large number ofpossible insertion positions and angles of insertion.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

It should be appreciated that various directional terms such ashorizontal, vertical, left right, downward, upward, etc. have been usedin conjunction with the orientation of depictions in the drawings.Applications consistent with the present invention may include usage oflike components in other orientations.

It should be appreciated that biasing of the locking/unlockingcomponents of various versions of a depth stop for a biopsy cannuladescribed herein are advantageously formed out of an elastomericmaterial for economical manufacture. However, an assembly of rigidcomponents biased by springs for biasing and/or actuating controls tomove the locking surface out of engagement may be substituted to achievesimilar results consistent with aspects of the present invention.

For example, the positioning and height of a central web of a breastcoil may enable use of a medial grid plate used with a rotatable cubeand penetrate from the medial side of the breast. For another example, agrid having a different geometric shape, such as hexagonal, may beemployed.

As another example, each grid aperture of equilateral polygonal lateralcross section in a grid plate taper toward their distal opening toground a similarly tapered guide block.

What is claimed:
 1. An apparatus for guiding a biopsy instrument withrespect to a breast compressive surface having a plurality of gridapertures, the apparatus being insertable at different orientations intoone or more grid apertures selected from the plurality of gridapertures, the apparatus comprising: a guide device comprising a bodysized and shaped to be received in one or more of the grid apertures,wherein the body comprises: a first pair of opposed faces, with at leastone guide hole extending between the first pair of opposed faces,wherein a first axis passes through both faces of the first pair ofopposed faces, and a second pair of opposed faces, with at least oneguide hole extending between the second pair of opposed faces, wherein asecond axis passes through both faces of the second pair of opposedfaces, wherein the second axis is non-parallel relative to the firstaxis, wherein the body is insertable into a first grid aperture of thegrid apertures along an axis of insertion that is parallel to the firstaxis, wherein the body is insertable into the first grid aperture alongan axis of insertion that is parallel to the second axis.
 2. Theapparatus of claim 1, wherein the grid apertures comprise squareapertures having a depth less than a lateral height and width of eachsquare.
 3. The apparatus of claim 1, further comprising a groundingstructure attached to a selected one of the guide device and the breastcompressive surface blocking distal movement of the guide device out ofthe grid apertures of the breast compressive surface.
 4. The apparatusof claim 3, wherein the grounding structure comprises a lateral lipalong a distal opening of each grid aperture in the grid plate.
 5. Theapparatus of claim 3, wherein the grounding structure comprises anenlarged proximal portion extending from the guide device.
 6. Theapparatus of claim 1, further comprising a pair of compressive surfacesmovably attached to a patient support surface on opposing sides tolocate the patient's breast, a selected one of the pair of compressivesurfaces further comprises a grid plate comprising a plurality of gridapertures accessible from an aft side and at least substantially openfrom a front side presented to the breast.
 7. The apparatus of claim 6,wherein the grid plate comprises a lateral fence and the othercompressive surface comprises a medial fence.
 8. The apparatus of claim1, wherein the at least one guide hole extending between a selected oneof the first pair of opposed faces and the second pair of opposed facescomprises a through hole aligned nonorthogonally between the selectedone of the first pair of opposed faces and the second pair of opposedfaces.
 9. An apparatus for guiding a biopsy instrument into a breast ofa patient supported upon a patient support surface, the apparatuscomprising: a pair of compressive surfaces movably attached to thepatient support surface on opposing sides to locate the patient'sbreast; a selected one of the pair of compressive surfaces furthercomprising a grid plate comprising a plurality of grid aperturesaccessible from an aft side and at least substantially open from a frontside presented to the breast; and a guide device shaped for insertioninto a selected one of the grid apertures and having at least first andsecond pairs of opposing faces, wherein said guide device comprises atleast two sets of converging angled through holes, wherein each set ofconverging angled through holes extends between different pairs of thefirst and second pairs of opposing faces and are sized to receive abiopsy instrument cannula, wherein a first axis passes through theopposing faces of the first pair of opposing faces, wherein a secondaxis passes through the opposing faces of the second pair of opposingfaces, wherein the second axis is perpendicular to the first axis,wherein the guide device is insertable into a selected one of the gridapertures along an axis of insertion that is parallel to the first axis,wherein the guide device is insertable into a selected one of the gridapertures along an axis of insertion that is parallel to the secondaxis.
 10. A guide device for use in guiding a biopsy instrument withrespect to a compression member having a plurality of grid aperturesextending therethrough, the guide device comprising: a body configuredto be received in one or more of the grid apertures, the body havingmultiple guide holes extending therethrough, wherein the body comprisesa first face and a second face, wherein the first face and the secondface are non-opposing, wherein a first axis passes through the firstface, wherein a second axis passes through the second face; wherein thebody is rotatable about a selected one of the first axis or a third axisto insert the body in a grid aperture of the plurality of grid aperturesalong an axis of insertion that is parallel to the first axis, tothereby position a first guide hole in the first face for guiding abiopsy instrument through the compression member; and wherein the bodyis rotatable about a selected one of the second axis or the third axisto insert the body in a grid aperture of the plurality of grid aperturesalong an axis of insertion that is parallel to the second axis, tothereby position a second guide hole in the second face for guiding thebiopsy instrument through the compression member.
 11. The guide deviceof claim 10, wherein the second axis for rotating the body is generallyperpendicular to the first axis for rotating the body.
 12. The guidedevice of claim 10, wherein the body further comprises at least two pairof opposed faces, each pair of opposed faces having one or more guideholes extending therethrough.
 13. The guide device of claim 12 whereinthe body comprises a cube-like structure.
 14. The guide device of claim12, wherein the one or more guide holes extending between the at leasttwo pair of opposed faces are non-intersecting.